Event history analysis on racial disparities in the path to adoption for Black and White children.

BACKGROUND: Black children are significantly overrepresented in many phases of the U.S. child welfare system. OBJECTIVE: The purpose of this study is to investigate racial disproportionality and disparities in the adoption process and factors that predict the length of time to adoption. PARTICIPANTS AND SETTING: This study utilized administrative data from the 2014 year of the Adoption and Foster Care Analysis and Reporting System (AFCARS) collected in 50 States, the District of Columbia, and Puerto Rico. METHODS: The disproportionality metric (DM) and disparity index (DI) were constructed for Black and White children, and event history analyses were conducted to calculate the probability of adoption while considering the time to adoption finalization. RESULTS: DM indicated that Black children (0.81) were underrepresented in adoption, and DI indicated that the likelihood of adoption for Black children (0.73) was one third lower than that for White children. The event history analyses revealed that White children were 1.27 times more likely to be adopted than Black children. White children had considerably fewer days from termination of parental rights to adoption finalization with a median time of 273.5 days compared to 328 days for Black children. Factors that extended adoption time included child intellectual, physical, and emotional/behavioral disabilities, visual and hearing impairments, parental alcohol abuse and disability, and child maltreatment histories, while parental drug abuse and longer stays in out-of-home care shortened the adoption process. We also found a significant interaction effect of race and neglect on adoption. Neglected Black children had a longer time to adoption than neglected White children. CONCLUSIONS: More dedicated outreach programs and resources must be developed to ensure the effectiveness of adoption services and cultural continuity for Black children.

Medical and public health professionals' perceived facilitators and barriers of human papillomavirus (HPV) vaccination among African American adolescents in Shelby County, Tennessee.

Human papillomavirus (HPV) infects nearly 85% of sexually active Americans during their lifetime, causing most cervical and five other cancers. Routine HPV vaccination is recommended for adolescents to prevent HPV-attributable cancers, but HPV vaccination coverage remains low, especially in Tennessee. In 2021, 54.6% of the population in Shelby County, Tennessee was Black or African American, reporting higher rates of new cervical cancer cases than other counties in Tennessee. While medical and public health professionals (HPs) play a critical role in promoting vaccination coverage, little is known about the factors HPs perceive to influence HPV vaccination for this population. This study sought to explore HPs' perceived facilitators and barriers of HPV vaccination among African American adolescents. Qualitative individual interviews with 26 HPs in Shelby County were conducted between October 2019 and February 2020. Interpretive content analysis of the interview data guided by the socio-ecological model revealed several important themes regarding the facilitators and barriers across the individual, interpersonal, and community levels. At the individual level, parental vaccine hesitancy emerged as a leading barrier to HPV vaccination, while appropriate education facilitated the vaccination. At the interpersonal level, a lack of strong provider recommendations impeded HPV vaccination, whereas improved communication skills with patients facilitated the vaccination. Finally, the community-level barriers included a lack of education and social/religious norms; the community-level facilitators included community outreach efforts. HPs should consider development of comprehensive community-based approaches that leverage the facilitators and barriers at multiple levels to increase HPV vaccination among African American adolescents in this region.